Burden of Chemotherapy-Induced Neuropathy in School ged children

AuthorArtan Shkoza Mirlinda Likmeta Ledjan Malaj
PositionUniversity of Medicine, Tirana, Albania
IIPCCL Publishing, Tirana-Albania
Academic Journal of Business, Administration, Law and Social Sciences Vol. 1 No. 3
November 2015
ISSN 2410-3918
Acces online at www.iipccl.org
Burden of Chemotherapy-Induced Neuropathy in School ged children
M. D, Artan Shkoza
University of Medicine, Tirana, Albania
Msc., Mirlinda Likmeta
University of Medicine, Tirana, Albania
M. D, PhD, Ledjan Malaj
University of Medicine, Tirana, Albania
Chemotherapy-induced peripheral neuropathy (CIPN) is the most common neurological
complication in cancer treatment and probably the most common toxic neuropathy in our
environment. The aim of the study was to assess the incidence and discomfort caused by
neuropathic symptoms in children treated for hematologic cancers. The study included all
children admitted to the pediatric oncology service at the University Hospital Center “Mother
Teresa”, Tirana, by the year 2011 – 2013 divided in three diagnosis groups: acute lymphoblastic
leukemia, Hodgkin and non-Hodgkin’s lymphoma, or other solid tumors. In a prospective
cohort setting, data were collected by standard questionnaire for symptoms and signs of
neurological damage, according to The Pediatric - Modified Total Neuropathy Scale (Ped -
mTNS), as well as clinical evaluation of pin sensibility, vibration sensibility, muscle strength
and deep tendon reflexes (DTR). The results obtained from Ped-mTNS, showed the high
incidence of sensory and motor symptoms as well as functional deficits in balance and manual
dexterity in children treated with anticancer drugs. Ped-mTNS scores, as the first measure
designed to assess CIPN in school-aged children, are significantly higher for children
undergoing neurotoxic chemotherapy. Even though the neuropathy in these children was
relatively mild, it was associated with functional deficits in balance and manual dexterity,
suggesting clinical importance. An important limiting factor of this study is the exclusion of
children younger than 5 years old, whom discomfort is evident but not properly evaluated.
Keywords: Peripheral neuropathy, chemotherapy, toxicity in children.
Many pediatric cancer diagnoses now have 5-year survival rates of over 85 % due to
the use of multimodal treatment that often includes chemotherapy (Ries et al., 1999,
99). Unfortunately, a number of chemotherapeutic medications have potential long
term effects, including neurotoxicity. In the peripheral nervous system (PNS), this
toxicity often manifests as chemotherapy-induced peripheral neuropathy (CIPN);
while in the central nervous system, toxicities range from cognitive and intellectual
impairments to encephalopathy and coma.
Symptoms of neurotoxicity in the PNS are often under-recognized and undiagnosed
in adult patients (Markman, 2006, 275). Even less is known about the prevalence and
impact of CIPN in pediatrics. One major reason for sparse data has been the lack of
specific and sensitive measurement tools for CIPN in the pediatric population. The
most neurotoxic chemotherapeutic agents are vinca alkaloids, cisplatin and its

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